YANSS Podcast – Episode Three – Confabulation

As a motto for the sapient, “cogito ergo sum” is pretty fantastic. Every time I’m reminded of it, a twinge of pride flows through my veins. It makes me want to stand up straight and pronounce proudly to my cat, “I think, therefore I am,” and then take his blank stare and plaintive meow as confirmation of my vitality. To be human is to know you exist. It is to know you are, and to know you are you.

It’s fitting that Jules Cotard, a man who was a close friend of the philosopher Auguste Comte, would find a way to dull the edge of Descartes’ famous proclamation. In an era preceding automobiles and airplanes, Cotard transferred his interest in the philosophy of being into the medicine of being – neurology – and after serving as a military surgeon in 1870, Cotard joined a clinic that did what it could with the knowledge of the day. Cotard and others at the clinic treated those with what one lecturer at the time called “madness in all its forms.”

Cotard was one of the pioneers of neuroscience, connecting behavior to the physical locations in the brain. As he progressed in his career he became particularly interested in patients who exhibited aphasia, or difficulties with language. He would follow those patients past death to the autopsy table in search of the cause of their maladies, and he encouraged other doctors to do the same. Considering his background in philosophy, it must have been astonishing when he found a patient devoid of a sense of self. In 1880, Cotard introduced a newly identified medical condition to the world. He called it “delire des negations,” or negation delirium. Essentially, he had discovered a condition in which a person thought, “I think, therefore I’m not.”

He told an audience in Paris that sometimes when a person’s brain was injured in the just the right way that person could become convinced he or she was dead. No amount of reason, no amount of cajolative acrobatics could talk a person out of the fantasy. In addition, the condition wasn’t purely psychological. It originated from a physiological problem in the brain. That is, this is a state of mind you too could suffer should you receive a strong enough blow to the head.

There are about 100 accounts in the medical literature of people displaying what is now known as Cotard’s delusion. It is also sometimes known, unsettlingly, as walking corpse syndrome. If you were to develop Cotard’s delusion you might look in the mirror and find your reflection suspicious, or you may cease to feel as through the heartbeat in your chest is yours, or you may think parts of your body are rotting away. In the most extreme cases, you may think you’ve become a ghost and decide you no longer need food. One of Cotard’s patients died of starvation.

Cotard’s syndrome and its delusions are part of a family of symptoms found in other disorders that all share the same central theme – the loss of your ability to emotionally connect with others. It is possible for something to go very wrong inside your skull so that your brain can no longer feel a difference between a stranger and a lover. The emotional flutter of recognition no longer comes, not for your dog, your mother, or your own voice. If you were to see a loved one and not feel the love, you would scramble to make sense of the situation. Sans emotion, those things become impostors or robots or dopplegangers. If the connection is severed to your own image, it becomes reasonable to assume you are an illusion. Faced with such a horrifying perception, you will invent a way to deal with it.

What this reveals is your remarkable penchant for making shit up. For all of existence, there is an internal narrative upon which you cling, a story you construct minute-by-minute to assure yourself that you understand what is happening. Sufferers of conditions like Cotard’s delusion invent weird, nonsensical explanations for their reality because they are experiencing weird, nonsensical input. The only difference between these patients’ explanations and your own explanations is the degree to which they are obviously, verifiably false. Whatever explanations you manufacture at any given moment to explain your state of mind and body could be similarly muddled, but you don’t have fact checkers constantly doting over your mental health. Whether or not your brain is damaged, your mind is always trying to explain itself to itself, and the degree of accuracy varies moment to moment.

We call these false accounts confabulations – unintentional lies. Confabulations aren’t true, but the person making the claims doesn’t realize it. Neuroscience now knows that confabulations are common and continuous in the both the healthy and the afflicted, but in the case of Cotard’s delusion they are magnified to grotesque proportions.
One of the leading neuroscientists in our era, maybe the leading neuroscientist, is V.S. Ramachandran, and he is the guest in this episode of the You Are Not So Smart Podcast. I’ve included a transcript in the links, since the interview took place in a noisy room. It’s also in the lyrics section of the iTunes track. Ramachandran has written extensively about phantom limbs and paralysis as well as the confabulations often conjured by those who experience such problems. His research includes everything from mirror neurons to synesthesia, and you can find dozens of his fascinating lectures online. He is the director of the University of San Diego’s Center for Brain and Cognition, and he is the author of The Tell-Tale Brain and co-author of Phantoms in the Brain.

After the interview, as in every episode, I taste a cookie baked from a recipe sent in by a listener/reader. That listener/reader wins a signed copy of the book. This week’s winner is Stef Marcinkowski of Ontario, Canada. Her recipe for Kickass Cranberry Chocolate Cookies included a piece of art based on the last episode. This is her website. You can see the image and the cookies below. Send your recipes to david {at} youarenotsosmart.com.